A 62-year-old woman with metamorphopsia is diagnosed with an idiopathic full-thickness macular hole measuring approximately 500 microns with a cuff of subretinal fluid, and visual acuity of 6/36. The most appropriate management is:
- A Intravitreal anti-VEGF injection
- B Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade with postoperative face-down positioning ✓
- C Observation with serial OCT
- D Focal argon laser photocoagulation at the fovea
Correct answer: B. Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade with postoperative face-down positioning
Explanation
Full-thickness macular holes of stage 3 and above (greater than 400 microns) rarely close spontaneously and cause significant visual loss, so pars plana vitrectomy with internal limiting membrane peeling, fluid-air exchange and gas tamponade followed by postoperative prone positioning is the standard approach, achieving closure rates above 90 percent. Anti-VEGF agents do not close holes, laser at the fovea is destructive, and observation is reserved for small stage 1 impending holes where spontaneous closure may occur.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.